Friday, October 28, 2011

The next few months of our life are pretty unique if you aren't familiar with how medical school/residency works. I've found that most people's idea is some combination of Grey's Anatomy, Scrubs, and House, which is usually pretty far from reality.

The terminology usually confuses people, but medical school is 4 years and you are only ever known as a medical student or occasionally a sub-intern in the 4th year. You are officially a doctor when you graduate medical school, but you go on to further training, called residency. The first year of residents are called "interns." In Pediatrics, 2nd and 3rd year residents are known as "upper levels," "residents," or "senior residents." Also unique to Pediatrics and a few other specialties, "chief residents" are doctors who are elected to stay an extra year after 3rd year to serve in an administrative/leadership position. Beyond residency, doctors are known as "attendings" if they are in an academic setting where they are overseeing residents and medical students, or they are just board certified physicians. So, this next step is a 3 year training process, but it is a job where I am getting paid, etc. The climate of residency has changed a lot over the past 10 years, where they used to have no duty hour regulations but now, we are limited to 80 hour weeks with no more than something like 26 consecutive hours of patient care. New this year, interns are only allowed to do 16 hours in a row, eliminating overnight call. Most programs I've looked into have gone over to shift work, which a lot of people don't like for some reason, but I enjoy coming home at night so it sounds good to me. I guess I'll see what I think next year.

A few months ago, Mark and I decided on different parts of the country where we would be willing to move based mainly on places with good job opportunities for him. We landed on Seattle, Los Angeles, Dallas, Chicago, and New York. It was pretty easy for me to find some great programs to apply to because they are all big cities with good options. I sent in my application at the beginning of September, and we've set up all of the interviews between now and Christmas. After I visit and interview with the programs, I'll enter a list ranking all of the programs where I'd be willing to train into a national ranking website. All of the programs submit a list ranking their applicants and the computer matches you to one program. On Friday, March 16, we'll go up to campus and after some anticipatory festivities, everyone in my class along with everyone across the country will open envelopes at the same time and find out where they are going. Exciting!

So, between now and then, I'm going to try to keep the blog up to date with our travels around the country. We've already visited Seattle and it was a great start! It all started to feel real when our plane landed in Seattle and Mark and I started talking about how it could possibly be our next home. Mark is going to come to each city once with me so we can make a good decision together, and he is trying to network with some companies in each place to feel out the job market. It is a really exciting time for us, filled with a lot of unknowns but we are looking forward to this next step!

I started my 4th year of medical school in July. It is kind of hard to believe that my last year of school is finally here! On one hand, it has been a very long road and I'm ready to move on, but on the other hand, it is a little intimidating to think that I'll have an MD attached to my name in a matter of months. In the mean time, 4th year is amazing. Aside from a set of board exams, this year has no tests or grades and is much less stressful than the past three. There are three required rotations which include a sub-internship which is a general inpatient month where you are treated like a 1st year resident, an acute care month which is an ER or ICU month, and an outpatient clinic rotation. Other than that, there are 4 elective months for a total of 7 months, leaving a solid 4 months for vacation! Hooray!

My sub-I was in July and I was on an inpatient team at Children's that was half general pediatrics and half endocrine patients. I worked hard that month, but it was so exciting to finally take real responsibility for my patients. During 3rd year, there is always an intern (1st year resident) seeing the patient along with you, and they are the ones who are responsible for the patient. Often there are things going on with a patient that you don't know about because you aren't the primary physician. As a fourth year, you make decisions, write orders, call consults, answer nursing questions, and generally take full responsibility for the patients and although it is much more work, it is so much more fulfilling. There were some real challenges that came with those responsibilities, including dealing with a stressed out Mom who vented all of her frustrations on me in the middle of the hallway one day, but I learned so much from even that unpleasant experience. The fact that I enjoyed my sub-I so much was real confirmation that I chose the right career path!

August was my outpatient clinic month, and I did 1 week in the pedi endocrine clinic, 2 weeks in the pedi rheumatology clinic, and they let me spend 1 week out at Camp John Marc for Camp Joint Adventure! It was so awesome to spend time at camp again. I worked mainly with the horses, which was a totally new experience for me and I have a new appreciation for the hard work it takes to work out there. It was really refreshing to spend time outside and get out of the hospital/clinic for a while. I hope there is a time in the future when I can be in a camp setting again, it is such a neat place.

September was a dermatology elective, affectionately known as derma-holiday because I averaged 2 days of work per week with a few lectures here and there. I learned a little bit, but mostly enjoyed some free time and studied for my boards which I took at the end of the month. No more tests for the year!

October was my acute care month which I spent in the neonatal ICU. It was a completely different world. For the first week and a half, I had only the lower-level care patients, but by the second week, I started taking care of a baby who was born at 27 weeks. That translates to a little over 3 months early, and he weighed 1 lb 12 oz. Tiny. Unbelievably tiny. The first day, it was scary to even touch him, but I got to know my little friend pretty well by the end of the month. He had a lot of major issues to face in the first few weeks of his life and he was by no means through the worst of it when my time in the NICU was over. There were a lot of babies who had a pretty rough start to life and there were some difficult times, but I'm so thankful for the experience. I got to know a few mothers well, spending time with them daily at a point in their life that held so much uncertainty.

This month is Radiology, and the start of interview season. I'm missing a little over 1/2 of this rotation for interviews, and the rest of it is super easy. I go to lectures from 10-2 some days, and other days (like today, where I'm drinking coffee and watching Let's Make a Deal as I blog) I have nothing! I've spent some time thinking about what I'm going to do with my free time over the coming months. I've decided to pick back up with the Rosetta Stone and get better at Spanish, which was basically decided for me when I became a Lopez. I also became a member of Pinterest, which I'm hoping will inspire some fun crafting and delicious new recipes, but so far I've just spent a lot of time browsing. I grew up playing the piano, but when I realized that may not be the easiest instrument to always have around, I got a guitar. I took lessons for a little while in college, but haven't played in a while so I have big dreams to self-teach, but we'll see how that goes. Other than that, I'm open to ideas for new hobbies!

Next month I have off, and then in January I'm taking "Philosophy of Medicine" which has some interesting reading/discussion topics. I won't lie though, I was also attracted to the elective due to the schedule....Tuesday/Thursday for 2 hours. Yep. I'm about to live life. I'm hoping in February to be able to take a Public Policy elective where I'll spend 2 weeks in Austin learning about Medicare/CHIP/WIC

Wednesday, October 26, 2011

Last rotation of 3rd year was Psychiatry. To be honest, that was on purpose because Psychiatry was known for being a little more laid back than the rest. It did not disappoint.

For the first 3 weeks, I was on Parkland Consults, meaning anywhere in the hospital that a team felt a Psychiatrist was needed for a patient, we went to see them. Sometimes, this meant a team was trying to cover their own tails and it wasn't very interesting/necessary to get Psychiatry on board, but most of the time it was really (I found myself starting to type "crazy" here, but that's not PC, but now I can't think of a better word...) ...wild. The second half of the rotation I spent on inpatient Psychiatry in Parkland which is a locked-down ward. I also went to mental illness court which is where patients go who are trying to get out of the hospital when the doctors don't think they should leave. Finally, I spent 3 shifts in the Psych ER, which was the most intense experience of all. I'll sum up this rotation with a couple of good stories:

A woman with underlying dementia who became delirious (there is a big difference between delirium and dementia and if you learn that, you learn a very important Psychiatry topic) who told me stories about her maggot friends and how they walked in a line and she saw them on the ceiling and it was strange how they walked together because, everyone knows maggots don't walk in a line, just ask science and they'll tell you. She also told me I looked like "one of them girls on the shows who is always hanging out with the boys" and to tell my husband to keep me in line. I'm pretty sure she was calling me a floozy, but I tried not to read into it.

Another woman had the most beautiful singing voice, but the problem was she would sing gospel music at the top of her lungs early in the morning which aggravated all the other patients on the ward. One day I walked in and told her good morning and she stopped me to tell me she had a revelation. When I asked what it was about, she said it came in the version of a song and started belting out Steve Miller's "Fly Like an Eagle."

In all seriousness though, I think mental illness can be one of the most difficult things a patient and their family can face. It is different from other medical illnesses both in how it is approached and how the public receives it. There are so many challenges to coping with, treating, and handling mental illness. I think the Church went through a period of time where it failed to see psychiatric illness as a true medical problem and people were often ashamed of it and saw it as spiritual failure when it is often just as organic as a heart attack. There is a fine line between recognizing that a medication is necessary and relying on it, but I firmly believe that medication for mental illness has a place along with faith, community, and prayer.

OB/GYN was my second to last rotation of 3rd year and I was starting to feel like it was the home stretch. I did gynecology first and it was not my favorite. I spent a lot of time in the OR watching hysterectomies and other surgeries that would make a person cringe if I described them. If there is one thing I figured out early on, the OR is not my favorite place to be. I think I might enjoy it more if I wasn't so freaked out the whole time that I was going to touch the wrong thing and contaminate it and have the wrath of a scrub nurse fall on me. But even besides that, gynecology surgeries are in a particularly difficult place to watch if more than 2 people are standing around the patient, so I spent hours pretending to be attentive when all I could see was the back of people's heads. I made to-do lists in my head, memorized the order of advertisements on the computer screensaver in the room, and basically tried to save myself from a death caused by boredom. Gynecology clinic was OK, a better learning experience but mostly a little gross in my opinion. Then I did a week of urogynecology where I learned everything there is to know about urinary incontinence and basically learned to fear the consequences of child bearing. I'm mostly kidding...The second half of the rotation was the obstetrics part which I enjoyed a lot more. Being a part of delivering a baby was an unforgettable experience. I had a hard time not getting choked up everytime I was in a delivery because it was just such an amazing sight to see the faces of the mothers and fathers as they saw their little one for the first time. It was at this point that I realized Pediatrics was it for me, because I always found myself wishing I could go with the baby over to the warmer instead of finishing up with the mom. After a while, you also start to recognize the personality types that certain fields of medicine attract, and I am not quite the ob/gyn type. Not really sure how to explain it, but it is just a feeling you get I guess.

Over spring break this year, Mark and I went to Zihuatanejo, Mexico. Mark did about 8 posts on his blog: Bongos and Peaches last April, so I won't put all the pictures on this one, but check it out of you're interested. Mark takes some seriously awesome pictures, I'm always impressed by what he captures.

Although it has been quite a while since I've posted, and it seems like forever since my Internal Medicine rotation, I'm still going to try to fill in the blanks over the past year. I guess when I'm this far removed from the experience, I'll only remember the important stuff anyway.

Internal Medicine was a 3 month rotation, the longest of the year. My first month was my Parkland ward month, which is notorious for being the toughest. By the way, I learned recently that I've used the word notorious incorrectly in the past, using just as "well known," but Mark informed me recently that it is basically the same as "infamous." So, I'm using it now in it's correct context :) Internal Medicine is basically just adult medicine, and it covers a really wide range so it was a densely packed learning experience. People often ask me when I tell them I'm going into Pediatrics if I have a hard time seeing sick and suffering kids. Obviously, yes that can be difficult, but I had a harder time on Internal Medicine seeing a lot of people with disease processes that there wasn't much to be done about. During my Parkland month, we had a lot of chronic liver disease and cancer, two diseases that can have a pretty mean course. I was thankful for the opportunity to work with and learn from these patients, but I figured out pretty quickly that Internal Medicine was not going to be the path I would take.

My second month was at Baylor in Dallas, my first private hospital experience. It was a different world I stepped into, a world of insurance and discussions about what a patient could pay for based on their coverage, something I was not used to. On one hand, it was nice to know that many patients had good places to go when they left the hospital, and we didn't have to battle the "which transitional care/nursing facility will take this person who doesn't have funding" dilemma. On the other hand, there were a few times I saw, what I thought was, medicine practiced for financial gain. Meaning, patients staying in the hospital longer than necessary, or tests ordered that I had learned did not give much valuable information. It was a strange, unpleasant feeling to talk about how a patient needed to be transferred to Parkland because they weren't funded, or that they wouldn't be able to receive life-saving dialysis because they were Medicaid and they would need to get in line at Parkland for their treatments. It was not a setting I particularly enjoyed, and even though there are times I get frustrated with the crowded rooms or long wait times at Parkland, it made me thankful to learn medicine in a county hospital.

My last month was outpatient clinics which was really enjoyable. I am pretty sure I want to practice outpatient rather than inpatient medicine, or at least a combination of the two. I spent time in clinics specializing in Infectious Disease, Nephrology, Endocrinology, Cardiology, Gastroenterology, and general Medicine. Almost all of it was at the VA Hospital, which I grew to love. It was a great learning experience and pretty laid back, so a fun way to end a marathon of a rotation. After I finished the exam at the end of this block, I realized just how much I learned and how great a foundation those 3 months helped to build.